National Council for Education Support Professionals

Individual / Associate Membership Form

(Please print out this form, then fill it out and mail it, with your membership payment, to the address given below.)

MAILING INFORMATION:

Last Name_____________________First Name___________________M.I. __________

Address_________________________________________________________________

City___________________________________State_____________Zip Code_________

Home Phone:________________________ Work Phone:_________________________

Fax Number:_________________________E-mail Address:_______________________

JOB TITLE______________________________________________________________

JOB CATEGORY: Please check the appropriate classification

_____Building and Grounds Maintenance and Repair

_____Security Services

_____Food Services

_____Health and Student Services

_____Paraprofessional

_____Secretarial, Clerical, Administrative Services

_____Technical Services

_____Trades, Crafts, Machine Operators

_____Transportation, Delivery, Vehicle Mechanics

GRADE LEVEL: Please check the appropriate levels

_____Pre-K

_____K-12

_____Higher Ed

LEADERSHIP POSITIONS HELD:

Local___________________________________________________________________

State____________________________________________________________________

National_________________________________________________________________

MEMBERSHIP INFORMATION: Please check one

_____I am a NEW member

_____I am a renewing member

PAYMENT INFORMATION: Please check one

_____I am ESP and want to have an Individual, voting membership ($20.00)

_____I am ESP and want to have an Associate, non-voting membership ($10.00)

_____I am Not ESP and would like to have an Associate, non-voting membership ($10.00)

Please make your check payable to the NCESP and mail a copy of this membership form to :

Attn: NCESP

National Education Association

ESP Quality

1201 16th Street, NW # 410

Washington, D.C. 20036

****NOTE****

• Only checks and money orders are acceptable. PLEASE DO NOT SEND CASH.

• Please keep a copy of this form for your own records.

• NOTE: This form is for Individual and Associate members. If you are joining as an ESP Organization, please use the Organization Membership Form.

National Council for Education Support Professionals